SHM Converge Scientific Abstract ePoster Gallery-A Curious Case of Atezolizumab-Associated Rheumatic and Musculoskeletal Adverse Effects

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This document describes a case of a 71-year-old man with stage II small cell bladder cancer who developed fever, neck stiffness, diffuse muscle aches, and later joint pain after receiving cisplatin, etoposide, and the checkpoint inhibitor atezolizumab. He was initially evaluated for serious infection, including meningitis and septic arthritis, but extensive testing was negative. Synovial fluid from an effused knee showed calcium pyrophosphate crystals, indicating pseudogout, yet his ongoing fevers and widespread musculoskeletal symptoms did not fully improve until he was started on high-dose systemic steroids. His symptoms then resolved significantly, and the illness was concluded to be a rheumatic immune-related adverse event (irAE) from atezolizumab. The drug was discontinued, steroids were continued for 4–6 weeks, and he had no recurrence of symptoms over the following year.<br /><br />The discussion emphasizes that immune checkpoint inhibitors have improved cancer outcomes but can cause a broad range of immune-related toxicities affecting many organ systems. Rheumatic and musculoskeletal irAEs are less commonly recognized than colitis, hepatitis, or pneumonitis, but can include inflammatory arthritis, arthralgia, myositis, polymyalgia-like syndromes, vasculitis, sicca symptoms, and even severe scleroderma-like disease. The report highlights the importance of early recognition, exclusion of infection, and multidisciplinary management involving oncology, rheumatology, infectious disease, and other specialists to prevent complications and improve outcomes.

Asset Subtitle

Hanish Jain

Meta Tag

Author List Elinor Mody, Garima Singh, Hanish Jain

Category Clinical Vignettes

Concept Immune-Related Adverse Event

Concept Immune Checkpoint Inhibitor Therapy

Concept Rheumatic Disease

Concept Musculoskeletal Disease

Concept Inflammatory Arthritis

Distinguished Non-Finalist

Presenter Organization SUNY Upstate Medical University

Presenting Author Hanish Jain

Track Adult

Keywords

small cell bladder cancer

atezolizumab

immune-related adverse event

rheumatic toxicity

pseudogout

checkpoint inhibitor

systemic steroids

inflammatory arthritis

fever and neck stiffness

musculoskeletal symptoms

Immune-Related Adverse Event

Immune Checkpoint Inhibitor Therapy

Rheumatic Disease

Musculoskeletal Disease

Inflammatory Arthritis